I will preface my answer by saying I do primarily drainless abdominoplasties. With that being said I think both techniques are very effective and as others have mentioned you should choose the surgeon you trust and get consistent results. The complication profile between the two techniques when done correctly is very similar, specifically the risk of seroma formation. Some studies actually showed a decreased risk of seroma with the drainless.

Some patients just have a significant aversion to drains for a multitude of reasons; pain, squeamish about bodily fluids, anxiety about drain removal, the headache of recording drain outputs, restrictions on showering after surgery, etc. For these patients the drainless technique will provide great benefit.

I strongly disagree that you "cannot pull as tight" with the drainless technique. The progressive tension sutures that make the drainless technique possible actually offloads tension on the incision allowing you to pull the flap very tight.

I will be the first to admit that there are tradeoffs with the drainless technique. Most notably, increased operative time to place the progressive tension sutures (usually 15-30min). There can also be temporary dimpling of the skin in areas of the progressive tension sutures but this goes away within a few weeks. There are also rare circumstances during surgery that I may feel inclined to leave a single drain for a few days but this is uncommon.

You should go with your gut and choose the surgeon you are most comfortable with. Best of luck with your decision!

Answered by Dr. WegerifSeptember 22, 2023

Tummy Tuck

Q Do I need a tummy tuck? Or what can be done about stomach loose skin? (Photo)

Congratulations on your weight loss! This is a very difficult question to answer without doing an examination. The safe answer is probably a tummy tuck but based on your photos its possible you could also be a candidate for Lipo with a skin tightening device like Bodytite or J-Plasma.

Factors that make lipo/skin tightening a reasonable option are skin quality and age. If you don't have any stretch marks and are less than 25 years old it may be reasonable. Another thing to consider is if you need a diastasis repair you would be better served with a tummy tuck.

If you end up doing lipo/skin tightening then skin laxity is always a possibility and the only way to improve that would be a tummy tuck so it also comes down to what you are willing to tolerate in terms of getting a secondary procedure. Best of luck with your plastic surgery journey.

Answered by Dr. WegerifSeptember 20, 2023

Breast Reduction

Q Breastfeeding before breast reduction, should I be concerned about the presence of milk 9 days pre-op?

Congratulations on your upcoming surgery. Every surgeon has their own recommendations but generally speaking if you were my patient and had stopped breastfeeding at least 6 months ago but were still producing a small amount of milk I would move forward with surgery. I would advise you that you have a slightly increased risk of forming a lactocele (milk cyst) that may require medication or drainage to treat. Best of luck with your surgery!

Answered by Dr. WegerifSeptember 20, 2023

Breast Augmentation

Q Considering a breast augmentation after weight loss - will I need a lift in addition to implants?

Congratulations on your weight loss! That is a huge accomplishment. Accurate measurements are necessary to to give a definite answer but strictly based on your photos you would likely be a candidate for augmentation without lift if you were ok with a larger size implant to accommodate the skin envelope. Another important consideration is the technique used; I would recommend a dual plane 2 or 3 submuscular implant placement. This will allow for the upper portion of the implant to be covered by muscle and conceal rippling but the lower portion of the implant will be covered by the glandular breast tissue allowing the implant to fall into a more natural position in relation to the nipple.

If you only wanted a very small implant you would likely require a lift.

Answered by Dr. WegerifSeptember 20, 2023

Tummy Tuck

Q Suture granuloma at muscle repair. Will this compromise the muscle repair?

If you developed an issue with a sure in the acute post operative phase of recovery and remove one of the plication sutures less than 3-6 months after the procedure it could compromise the results because your body hasn't been able to form strong scar tissue keeping the muscles together but after two years I would be surprised if your muscular plication was effected by a suture removal. As always, it's best to consult with your surgeon because they may have additional information about your case that is leading to their recommendation. Wishing you the best.

Answered by Dr. WegerifSeptember 20, 2023

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